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Organization
WILLOW CREEK CHIROPRACTIC, PA
Active
Organization
WILLOW CREEK CHIROPRACTIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DOUGLAS HEAD DC (PRESIDENT)
(651) 784-3396
Entity
Organization
Contact information
Practice address
5922 LEXINGTON AVE N, SHOREVIEW, MN 55126-5604
(651) 784-3396
(651) 784-7247
Mailing address
5922 LEXINGTON AVE N, SHOREVIEW, MN 55126-5604
(651) 784-3396
(651) 784-7247
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3281
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
231934
CCMI ID
MN
01
—
35923HE
BCBS INDIVID PROVIDER NUM
MN
01
—
35P22WI
BCBC OF MN CLINIC ID
MN
01
—
4400056
MEDICA
MN
05
—
7711328-00
—
MN
01
—
79279
UPIN FOR HEALTHPARTNERS
MN
Enumeration date
11/03/2006
Last updated
08/27/2008
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